Clinical value of surgical intervention and decision-making dilemmas for elderly patients of rib fractures: a systematic review and meta-analysis.

BACKGROUND

For elderly patients, when weighing the benefits and risks associated with surgery, the treatment strategy remains controversial. Our objective was to compare clinical outcomes between surgical and non-surgical management of rib fractures in patients aged ≥60 years.

METHODS

PubMed, Embase, Cochrane Library, and Web of Science were searched for studies comparing surgical intervention with non-surgical treatment in elderly patients of rib fractures over the past decade. The mean differences (MDs) for continuous outcomes, the risk ratios (RRs) for binary outcomes, and the 95% confidence intervals (CIs) were calculated. Meta-analysis was performed using Review Manager (RevMan) version 5.4.

RESULTS

Ten studies were included with a total of 98,004 patients, of whom 2,478 underwent surgical intervention. Compared with non-surgical treatment, surgical intervention was associated with lower mortality (RR =0.61, 95% CI: 0.49, 0.75, P<0.001), longer hospital stay (MD =5.75, 95% CI: 4.50, 7.01, P<0.001), longer intensive care unit (ICU) stay (MD =2.16, 95% CI: 0.21, 4.11, P=0.03), and lower readmission risk (RR =0.30, 95% CI: 0.11, 0.79, P=0.01). No significant differences were noted in the incidence of pneumonia (RR =1.21, 95% CI: 0.50, 2.92, P=0.67), pleural effusion (RR =0.32, 95% CI: 0.03, 3.60, P=0.36), pneumothorax (RR =0.43, 95% CI: 0.04, 5.15, P=0.51), respiratory failure (RR =1.10, 95% CI: 0.50, 2.43, P=0.81) and duration of mechanical ventilation (DMV) (MD =-0.22, 95% CI: -1.25, 0.81, P=0.68). Subgroup analysis showed no significant difference in mortality among patients aged ≥80 years (RR =0.87, 95% CI: 0.59, 1.29, P=0.49).

CONCLUSIONS

Elderly patients of rib fractures may benefit from surgical intervention, particularly those aged under 80 years. For super-elderly patients aged ≥80 years, the value of surgical intervention is not obvious. For this population, high-quality prospective studies are needed to further clarify the clinical value of surgery.